Provider Demographics
NPI:1609822626
Name:INDEPENDENT MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:INDEPENDENT MEDICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:NAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-739-9171
Mailing Address - Street 1:1625 2ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-1706
Mailing Address - Country:US
Mailing Address - Phone:256-739-9171
Mailing Address - Fax:256-739-9356
Practice Address - Street 1:1625 2ND AVE NW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-1706
Practice Address - Country:US
Practice Address - Phone:256-739-9171
Practice Address - Fax:256-739-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL368332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009605860Medicaid
AL51031056INDOtherBLUE CROSS PROVIDER NUMBE
AL1063550001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER